BLD-05-0497
CI
.~
City of Yelm
Community Development Department
Building Division
Phone: (360) 458-8407
Fax: (360)458-3144
Permit No
I
BLD-05-0497-YL
Issue Date 03/16/2006
(Work must be started within 180 days)
Receipt No
41156
Applicant:
Name. West Coast Home Improvement
Phone:
360-786-1111
Address. 10517 Farwest Ct
City' Yelm
State. WA Zip 98597
Property Information,
Site Address 15731104th Ave. SE
Assessor Parcel No. 85840007600
Subdivision.
Lot:
Contractor Information
Name. Applicant
Contact:
Phone:
Address.
City'
State:
Zip
Contractor License No
Expires.
Business License.
Project Information
Project: Stober Patio Cover
Description of Work: 12x24 Patio Cover
Sq Ft. per floor (1st) 0
(2nd) 0
(3rd) 0
Garage 0
Basement 0
Heat Type (Electric, Gas, Other):
Fees.
Item
Item Fee
Base Amt
Unit Fee
Unit Rate
No Units Unit Desc
Building Permit - Other
TOTAL FEES
69.25
$69.25
000
000
o 0000
00000 $1,000
Applicant's Affadavit:
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the propose structure is in conformity with all applicable City of
Yelm regulations incl ng those governing zoning d land subdivision, and in addition, all covenants,
easements and res ions of record. If applying a contractor, I futher certify that I am currently
registered in the e of Washington.
OFFICIAL USE ONLlY
,
. # Sets of Prints.
Signature
Date
By'
Firm
It : .
- .
lii)~:~,.tI!:'.~~~"~'.~i CITY O. F
.~ ~ YELM
:;;{../?i<~~ .
/r,~1 ,.,.::::~,_... PO Box 479
(' :;,'J_J 1 elm WA 9859-'
t!E.b'E=:J J,6\1-453-3403
RECEIPT No 41156
FiECEI VED
....SIXTY NINE DOLLARS & 25 CENTS
RECEIVED FROM
WEST COAST HOME IMPROVEMENT
10517 FARWEST CT
YELH. WA 98597
786-1111
DATE REC NO
03/16/06 41156
AMOUNT
69.25 CHECK
REF NO
9897
BUDGETARY
MICHELLE
---BULDP-ER BLD-05-0497 -YL
STOBER PATIO COVER
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Project Address:
Subdivision ydW\ -\"~.(fr..-..
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
I 5" I 31 I D q "'/""L a ve. st' Parcel #.
Lot#.
~ New Construction D Re-Model / Re-Roof / Addition D Home Occupation Sign
D Plumbing D Mechanical D Mobile / Manufactured Home Placement D Other
Project Description/Scope of Work: f A~ D (1 (') 0~ r
Project Value.
:1..00D
Building Area (sq ft) 1st Floor
Basement
2nd Floor
Carport
Garage Deck
Patio d <6'ir '5 7
# Bedrooms_
# Bathrooms_
Heating: GAS/OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel? If yes, a
completed environmental checklist must accompany permit application
EMAIL
TELEPHONE ']60 Lfoo - /103
LICENSE #
EMAIL
ZIP z.l./ 5"'0 3 TELEPHON
:GE~~~LCONT~~gtQRwe.s-t 4,ST ~ ::r:..~ TELEPHONE lit> ~
ADDRESS I ?,":?:lD Jl'S LnJ S E- EMAIL t...lt.Si(.~S.rqc...>~Ih..$~a.n/.Cd~
CITY 'f,JlN"\. STATEw&. ZIPqgZ;7~ FAX(~6D) ltSK-09K3
CONTRACTOR'S LICENSE #l.tJest''-~/)7-'"7W1! P DATE6b CITY LICENSE # O(?-003 /74,,0
g!;i8MillNQ.~ON..T~J\QTQR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
ZIP
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
~"E~8ANJt~L QQ~TM<;:TQR
ADDRESS
CITY STATE
CONTRACTOR'S LICENSE #
ZIP
TELEPHONE
EMAIL
FAX
EXP DATE CITY LICENSE #
Copy of mitigation agreement with Yelm Community Schools, if applicable
I hereby cert! hat the above informatj n is correct and that the construction on, and the occupancy and the use of the
above desc ed property will be in a rdance with the laws, rules and regulations of the State of Washington and the
City of Y
II ~ cJb
All permits are non-transferable al1d will expire if work authorized by such permit is not begun
within 180 days of issuance, or if work is suspended or abal1doned for a period of 180 days
105 Yelm Avenue West
PO Box 479
Yelm, WA 98597
(360) 458-3835
(360) 458-3144 FAX
www.ci.yelm.wa.ul1
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General/Specialty Contractor
A business registered as a construction contractor with Lal to perform construction work within the scope
of its specialty A General or Specialty construction Contractor must maintain a surety bond or assignment
of account and carry general liability insurance
License Informatiol1
License WESTCHI027MB
Licensee Name WEST COAST HOME IMPROVEMENT
Licensee Type CONSTRUCTION CONTRACTOR
UBI 600587911 Verify Workers Comp Premium
Status
Ind. Ins. Account
Id
Business Type INDIVIDUAL
Address 1 10517 FARWEST CT SE
Address 2
City YELM
County THURSTON
State WA
Zip 98597
Phone 3604001530
Status ACTIVE
Specialty 1 GENERAL
Specialty 2 UNUSED
Effective Date 7/2/1998
Expiration Date 7/2/2006
Suspend Date
Separation Date
Parent Company
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Business Owner Informatiol1
Name Role Effective Date Expiration Date
OWNER 07/02/1998
Bond Information
Bond Bond
Company Account Effective Expiration Cancel Impaired Bond Received
Bond Name Number Date Date Date Date Amount Date
DEVELOPERS
SURETY ft Until
#4 INDEM CO 855377C 07/02/2002 Cancelled $12,00000 04/30/2002
DEVELOPERS
#3 INSCO 855377C 07/02/2001 07/0212002 $6,00000 06/26/2001
GRAN ITE
STATE INS Until
#2 CO 228138 07/02/1999 Cancelled 07/11/2001 $6,000 00
INDEMNITY
INS CO
NORTH
#1 AMERICA K06028676 07/02/1998 07/0211999 10/19/1999 $6,000 00
Savings Information
No Matching Information
Insurance Information
Company Policy Effective Expiration Cancel Impaired Received
Insurance Name Number Date Date Date Date Amount Date
AMERICAN
STATES
#6 INS CO 01CE40873080 07/0212004 07/0212006 $300,00000 06/03/2005 .
AMERICAN
STATES
#5 INS CO 01CE40873060 07/02/2003 07/0212004 $300,00000 OS/29/2003
AMERICAN
STATES
#4 INS CO 01CE40873050 07/02/2002 07/02/2003 $300,000 00 06/26/2002
AMERICAN
STATES
#3 INS CO 01CE40873040 07/02/2001 07/02/2002 06/26/2001
, AMERICAN
STATES
#2 INS CO 01CE4087303 07/02/2000 07/02/2001
II AMERICAN
STATES
#1 INS CO 01CE408730 07/0211998 07/02/2000
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